Virginia Garcia Ovejero Pivik (Host): Cancer is a disease that has affected countless lives, bringing uncertainty and challenges for families everywhere. When faced with the need for treatment, we search for the best possible options that offer hope, healing and the highest quality of care for the people we love the most. Joining me today is Dr. Jesus Esquivel. He's Board Certified in General Surgery and specializes in Oncology Surgery. Dr. Esquivel welcome.

Jesus Esquivel, MD: Thank you so much for having me.

Host: To kick things off, can you share a little bit about your journey into the world of oncologic surgery and what inspired you to specialize in this field?

Jesus Esquivel, MD: Yes, uh, when I came to this country, I had the opportunity to meet a very prominent doctor that then became my mentor. His name is Paul Sugarbaker, who specializes in the field of advanced abdominal cancers, doing a combination of surgery and chemotherapy at the same time, and I was very, very impressed. And I said, this is what I want to do with the rest of my career.

Host: Doctor, you're very well known for specializing in HIPEC. For those of us who may not be familiar with this term, could you please explain what HIPEC is and how it fits into treatment of certain types of cancer?

Jesus Esquivel, MD: Yes. Thank you. HIPEC stands for Hyperthermic Intraperitoneal Chemotherapy. There are patients whose tumor behaves like a ruptured balloon with tumor cells distributing throughout the entire abdomen and the pelvis. So we do surgery to remove those tumor nodules, but there's always going to be microscopic tumors left behind.

And for that, during the operation, we do an installation of heated chemotherapy up to 107 degrees Fahrenheit and lavage the abdomen for 90 minutes to take care of any of those cancer cells that are floating throughout the abdomen and the pelvis.

Host: You mentioned a couple of them, but I would like to ask you, what are some of the most common types of cancer that benefit from HIPEC, and how does this procedure compare to other treatments available out there?

Jesus Esquivel, MD: So the number one indication for HIPEC in 2025 is ovarian cancer, 80% of the patients with ovarian cancer will present with this ruptured balloon in which the tumors just spread on the surfaces of the abdomen. And we have scientific data from randomized trials, meaning that half of the patients got the treatment and half of the other patients did not get the treatment.

And those that received HIPEC derived a prolongation on survival from this particular treatment. For other tumors like appendix, the numbers are not there because these are very rare tumors and it's difficult to conduct those clinical trials and in colon cancer, those trials are ongoing at this time. So if we cannot deliver HIPEC, those patients will receive traditional intravenous chemotherapy.

Virginia Garcia Ovejero Pivik (Host): I understandthat HIPEC is normally referred to as localized treatment. I would like to ask you, what does that mean for the patients who undergo this type of procedure and how does it target cancers differently than traditional systemic treatments?

Jesus Esquivel, MD: The main difference is that the patients that have this particular type of treatment is for disease that has stayed in the abdomen. When other tumors spread through the blood, then for those patients, they will be receiving intravenous chemotherapy to target those metastases. But HIPEC is indeed a local, regional treatment to direct it at removing the tumors.

And then if you want to say it, the one two punch, with a combination of surgery and chemotherapy where the tumors are.

Host: On the clinical side, HIPEC is a relatively complex procedure. Could you please walk us through what happens during this surgery and what are some of the challenges that might be involved for both the surgical team and the patients?

Jesus Esquivel, MD: So when we started doing this combined approach, these patients would need an operation of over 12 hours and about three weeks of hospitalization. In this day and age, everything is a minimal invasive surgery, so we are trying to get HIPEC to be delivered in that particular approach, with smaller operations. We are not there yet, but without a doubt we are making significant progress.

In this day, an average operation is about seven hours and keeps the patient in the hospital between five and seven days.

Host: Speaking of the future and hearing now your passion for this topic, looking ahead, what innovations or advancements are you most excited about in the future, when it comes to oncologic surgery and HIPEC. And how do you see the future of cancer treatment evolving?

Jesus Esquivel, MD: I love that question. Because we always want to move the field forward and I envision that one day people like me, will be out of a job because most of the patients are going to be able to receive a treatment with systemic therapies, meaning something that is given in the vein and then goes and takes care of the disease that is in the abdomen and the pelvis. At the present time, as I mentioned before, we are working hard to try to reduce the aggressiveness of the operation, doing it minimally invasive in certain cases. And, but ideally the ultimate goal will be to help the body eliminate the cancer that the patient has. We're not there yet, but we are getting close.

Host: Doctor, at the very beginning of this podcast, we talked about the families everywhere that have been impacted by cancer and the patients. I would like to ask you to give some words of advice or some words of encouragement for all those patients and family members who might be watching this podcast or listening to this podcast and who might be concerned or doubtful or worried about the outcome of a procedure like this, what would you like to tell them?

Jesus Esquivel, MD: I would like to tell any patient that is diagnosed with this particular type of cancer, one of the common terms is peritoneal carcinomatosis; to seek a person that is experienced in the treatment of this disease. So for this reason, I highly recommend that any patient that has been told that what they need is HIPEC, to get a second opinion from a person that has a track record performing this particular type of treatment.

Host: Thank you so much for joining me today and for sharing such insightful information and compassionate information as well. Thank you.

Jesus Esquivel, MD: Thank you for having me.

Host: Surgery can be life changing, and so it's picking the right surgeon. Tell your doctor you want a Beebe surgeon. Thank you. See you next time.